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Cuba's delayed transition needs
Correspondence
Cuba’s delayed transition needs I welcome your Editorial on the complex crossroads at which Cuba finds itself (Aug 12, p 554).1 Cuba advanced peacefully through both World Wars, and in 1958 was promising to be a Caribbean tiger. But socialism failed after 1958, not because of the US blockade, but the self-blocked system. Cuba’s living standards and infrastructure were devastated by alignment with Russia and China against the free world. Cuba has been in stealthy transit since the 1970s, when it created overseas capitalist enterprises, seduced by Yugoslavia’s socialist market economy. Cuba’s ruined economy only survived because of subsidies from Russia (nearly half the annual gross domestic product [GDP] in 1959–89) and Venezuela (nearly a fifth of the annual GDP in 2000–06), self-cancelled foreign debts (1986), and foreign (US) family shipments (1993–2006). This backing has allowed Cuba to hide its inefficient autocratic central planning policy, and pass off inherited advances from before 1959 (panel) as the result of the socialist movement. In 1958, Cuba had 6000 physicians for 6 million inhabitants, an infant mortality rate of 32 per 1000 livebirths, a life expectancy of 62 years, and an advanced public–private health system (a Spanish/French/US mix). These indicators were close to those of North America and the UK and better than those of France, Germany, Italy, and Japan.2 Between 1959 and 2006, Cuba produced 15 times as many physicians as its population doubled, fuelling a high density of cheap labour similar to the unproductive Russian and Chinese health systems. In 1958, Cuba had the 14th lowest infant mortality rate in the world. It is 31st lowest now.3–5 One million inhabitants and several thousand physicians have emigrated from Cuba since 1959. Today, half of www.thelancet.com Vol 368 October 14, 2006
Cuba’s doctors work overseas where they get some relief from the penury they suffer at home, improving their knowledge and skills via the only foreign exchanges they are permitted to have. The government, of course, obtains great financing and political support for this. What Cuban doctors first need is liberty: specifically of information and dialogue. Second, they need the people of all modern countries to build professional bridges and provide support and collaboration to strengthen Cuba’s civil society, encouraging regime officials to evolve peacefully. It is crucial that they understand all the paths and be free to choose the best way to reconstruct the prosperous, self-sustained country that was Cuba before 1959.
Panel: Chronology of some advances in Cuba before 1959 1728 Foundation of Havana University Medical School (37 years before the first in the USA) 1792 Tomas Romay writes about elements of evidence-based medicine and clinical trials 1804 Tomas Romay begins smallpox vaccination campaign 1861 Foundation of Academy of Medical Sciences 1871 Cholera eradicated 1881 Carlos J Finlay postulates yellow fever’s causal chain 1901 Yellow fever eradicated at Havana, confirming Finlay’s hypothesis 1902 Establishment of self-sustained free-market economy and open democratic society 1909 Foundation of world’s first national health department 1923 Smallpox eradicated by vaccination (26 years before the USA) 1927 Foundation of Institute for Public Health 1950s Markedly lowered mortality from infectious diseases 1950s Cardiac diseases and cancer leading causes of death, stroke the fourth Main source: Capote Mir RE. [Evolution of health services and socioeconomic structure of Cuba. Parts 1-2]. Rev Cub Adm Salud 1979; 5: 107–117; 225–53.
I am a Cuban professional.
Anon [email protected] c/o The Lancet, 32 Jamestown Road, London NW1 7BY, UK 1 2 3
4
5
The Lancet. Planning for Cuba’s transition. Lancet 2006; 368: 554. United Nations. Statistical yearbook 1960, 12th edn. New York: United Nations, 1961. United Nations. Demographic yearbook 1966, 18th edn. New York: United Nations, 1967. McGuire JW, Frankel LM. Dimensions and determinants of mortality decline in prerevolutionary Cuba. Harvard Working Paper Series, vol 14, no 6. Cambridge, MA: Center for Population and Development Studies, 2004. http://www.hsph.harvard.edu/hcpds/ wpweb/McGuire_wp1406.pdf. United Nations Children’s Fund. The state of the world’s children 2006: excluded and invisible. Infant mortality rates for countries. New York: UNICEF, 2006. http://www. childinfo.org/areas/childmortality/ (accessed Sept 7, 2006).
I was astonished by your Editorial “Planning for Cuba’s transition”.1 You seem to have taken at face value the report of the US Presidential Commission for Assistance to a Free Cuba2—a document that has been widely dismissed, if not ridiculed, as pure propaganda by most Cuba experts in the USA. It is particularly in the health area that the report is regarded as most seriously off-base, if not dishonest.
With the highest ratio of physicians to population of any nation, and free, accessible health care for all, the Cuban people enjoy one of the best levels of health in the world. Cuba’s health indicators are on a par with those of most developed nations. Life expectancy in Cuba is 5 years longer than it is for African Americans,3 even though 70% of Cubans are of African origin. Infant mortality in Cuba is half what it is in most major US cities.4,5 Medical Education Cooperation with Cuba (MEDICC) has, over the past 6 years, sent more than 1400 US medical and public-health students (and a handful from the UK) from 114 schools of medicine to Cuba for 6-week electives with family doctors. Almost without exception they have returned impressed and inspired. In the course of operating the programme, the staff of MEDICC have interacted intensively with the Cuban health system at every level, and have become convinced that Cuba provides its people with exceptional service. It is laughable to suggest that the USA, incapable of providing a similar standard of care to much of its own
e-mail submissions to [email protected]
1323
Cuba’s delayed transition needs I welcome your Editorial on the complex crossroads at which Cuba finds itself (Aug 12, p 554).1 Cuba advanced peacefully through both World Wars, and in 1958 was promising to be a Caribbean tiger. But socialism failed after 1958, not because of the US blockade, but the self-blocked system. Cuba’s living standards and infrastructure were devastated by alignment with Russia and China against the free world. Cuba has been in stealthy transit since the 1970s, when it created overseas capitalist enterprises, seduced by Yugoslavia’s socialist market economy. Cuba’s ruined economy only survived because of subsidies from Russia (nearly half the annual gross domestic product [GDP] in 1959–89) and Venezuela (nearly a fifth of the annual GDP in 2000–06), self-cancelled foreign debts (1986), and foreign (US) family shipments (1993–2006). This backing has allowed Cuba to hide its inefficient autocratic central planning policy, and pass off inherited advances from before 1959 (panel) as the result of the socialist movement. In 1958, Cuba had 6000 physicians for 6 million inhabitants, an infant mortality rate of 32 per 1000 livebirths, a life expectancy of 62 years, and an advanced public–private health system (a Spanish/French/US mix). These indicators were close to those of North America and the UK and better than those of France, Germany, Italy, and Japan.2 Between 1959 and 2006, Cuba produced 15 times as many physicians as its population doubled, fuelling a high density of cheap labour similar to the unproductive Russian and Chinese health systems. In 1958, Cuba had the 14th lowest infant mortality rate in the world. It is 31st lowest now.3–5 One million inhabitants and several thousand physicians have emigrated from Cuba since 1959. Today, half of www.thelancet.com Vol 368 October 14, 2006
Cuba’s doctors work overseas where they get some relief from the penury they suffer at home, improving their knowledge and skills via the only foreign exchanges they are permitted to have. The government, of course, obtains great financing and political support for this. What Cuban doctors first need is liberty: specifically of information and dialogue. Second, they need the people of all modern countries to build professional bridges and provide support and collaboration to strengthen Cuba’s civil society, encouraging regime officials to evolve peacefully. It is crucial that they understand all the paths and be free to choose the best way to reconstruct the prosperous, self-sustained country that was Cuba before 1959.
Panel: Chronology of some advances in Cuba before 1959 1728 Foundation of Havana University Medical School (37 years before the first in the USA) 1792 Tomas Romay writes about elements of evidence-based medicine and clinical trials 1804 Tomas Romay begins smallpox vaccination campaign 1861 Foundation of Academy of Medical Sciences 1871 Cholera eradicated 1881 Carlos J Finlay postulates yellow fever’s causal chain 1901 Yellow fever eradicated at Havana, confirming Finlay’s hypothesis 1902 Establishment of self-sustained free-market economy and open democratic society 1909 Foundation of world’s first national health department 1923 Smallpox eradicated by vaccination (26 years before the USA) 1927 Foundation of Institute for Public Health 1950s Markedly lowered mortality from infectious diseases 1950s Cardiac diseases and cancer leading causes of death, stroke the fourth Main source: Capote Mir RE. [Evolution of health services and socioeconomic structure of Cuba. Parts 1-2]. Rev Cub Adm Salud 1979; 5: 107–117; 225–53.
I am a Cuban professional.
Anon [email protected] c/o The Lancet, 32 Jamestown Road, London NW1 7BY, UK 1 2 3
4
5
The Lancet. Planning for Cuba’s transition. Lancet 2006; 368: 554. United Nations. Statistical yearbook 1960, 12th edn. New York: United Nations, 1961. United Nations. Demographic yearbook 1966, 18th edn. New York: United Nations, 1967. McGuire JW, Frankel LM. Dimensions and determinants of mortality decline in prerevolutionary Cuba. Harvard Working Paper Series, vol 14, no 6. Cambridge, MA: Center for Population and Development Studies, 2004. http://www.hsph.harvard.edu/hcpds/ wpweb/McGuire_wp1406.pdf. United Nations Children’s Fund. The state of the world’s children 2006: excluded and invisible. Infant mortality rates for countries. New York: UNICEF, 2006. http://www. childinfo.org/areas/childmortality/ (accessed Sept 7, 2006).
I was astonished by your Editorial “Planning for Cuba’s transition”.1 You seem to have taken at face value the report of the US Presidential Commission for Assistance to a Free Cuba2—a document that has been widely dismissed, if not ridiculed, as pure propaganda by most Cuba experts in the USA. It is particularly in the health area that the report is regarded as most seriously off-base, if not dishonest.
With the highest ratio of physicians to population of any nation, and free, accessible health care for all, the Cuban people enjoy one of the best levels of health in the world. Cuba’s health indicators are on a par with those of most developed nations. Life expectancy in Cuba is 5 years longer than it is for African Americans,3 even though 70% of Cubans are of African origin. Infant mortality in Cuba is half what it is in most major US cities.4,5 Medical Education Cooperation with Cuba (MEDICC) has, over the past 6 years, sent more than 1400 US medical and public-health students (and a handful from the UK) from 114 schools of medicine to Cuba for 6-week electives with family doctors. Almost without exception they have returned impressed and inspired. In the course of operating the programme, the staff of MEDICC have interacted intensively with the Cuban health system at every level, and have become convinced that Cuba provides its people with exceptional service. It is laughable to suggest that the USA, incapable of providing a similar standard of care to much of its own
e-mail submissions to [email protected]
1323